Transgender Breast Augmentation Presents Unique Challenges


The transgender breast augmentation differs from a traditional breast augmentation in many important ways. These differences make choosing a board-certified plastic surgeon in the Columbus area even more important during this phase of your journey. 

The common breast augmentation is not the same operation that is needed for the transgender patient. The basics are similar, but there are nuances that make the top surgery unique. 

Does insurance cover transfeminine top surgery?

First, many insurance companies will cover this operation for trans female patients, but there is some paperwork that must be submitted to receive a pre-approval code. This is something that we will help facilitate, and if possible, accomplish. This process depends on your insurance and if they list the surgery as a covered benefit or as an exclusion. Then, your out-of-pocket expenses depend on your own deductible and co-pays that might apply to your contract with them. But if you have benefits for the surgery, you should take advantage of it. And then you can save some money for other fun plastic surgery options like a tummy tuck or facial enhancements. 

What can I expect during transgender breast augmentation?

The surgical approach for the trans female is unique as well. The size of the implants need to be larger in general, but often a different contour is chosen as well to complement trans female chest proportions. The skin envelope is probably the biggest variable and challenge, and it’s the factor limiting the size of the implants. Often it can be difficult to know how much stretch is possible, and multiple sizes must be ordered and tried out to determine the best fit. 

When this is the case, I try to infuse some humor and will say I am bringing the “bag of boobs” to the case, to determine intraoperatively the best fit. 

Where are the implants placed during top surgery?

The other unique factor about surgery is that the implants are placed on top of the muscle (non-trans augmentation implants can be placed on top or under the muscle). The nice thing about this surgical approach and pocket on top of the muscle is that there is quite a bit less pain afterward. Depending on the physique of the female, the sub-glandular pocket can look fantastic. If the patient is very thin, however, the implant may be more noticeable. The American Society of Plastic Surgeons offers additional details about transfeminine top surgery for your information.

How does hormone therapy affect top surgery?

One of the biggest factors is how long the patient has been doing hormone therapy and how developed their breasts are. In many cases, there is a nice amount of breast tissue, making the final result much better.

What is top surgery recovery like?

Another unique feature is during the post-operative phase. The settling process does take much longer for the trans female, again related to the elasticity of the skin envelope. At first, the implant does not move and will appear too high, hard, and round. Then as the skin stretches, the settling occurs and a natural contour is achieved. 

The implants are smooth, and round which is why they can have a more rounded look during this period of time. But ultimately, gravity wins and the settling occurs. At this point, the incision in the inframammary fold becomes concealed in the fold. 

How long do breast implants last?

As is the case in any augmentation, the implants are not considered a lifetime device. This means they need to be replaced after about 10 years. While ruptures are rare, they can occur. Rest assured that it is possible to see a rupture of a silicone gel implant with mammography and ultrasound, when these modalities are used. 

High Satisfaction for Top Surgery Patients

The one aspect of this operation that is similar for both types of patients is the overall patient satisfaction. EVERY patient is happier and feels better with more beautiful breasts. This rewarding reaction makes this operation one of my favorites to do. My trans female patients might even be happier after their surgery! 

Breast Wishes. 

If you want to discuss your top surgery options with Dr. Taylor, you can request a consultation using our online form or call our office at (614) 569-2649 to schedule an appointment.

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